Episodes of depression appear to last between 6 and 9 months in adolescents indicating that depression is a serious disorder in this group. Adolescent depression leads to serious problems in behavior, thinking, and of course mood at school, home, and in social situations; however, depression is treatable. Several medications have been demonstrated to be effective for treating depression in adolescents (references 1 and 2 for the whole paragraph).
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FDA Approved Medications
At the time of this writing only two antidepressant medications have been approved by the FDA, the Food and Drug Administration, for treating depression in adolescents. Fluoxetine (Prozac) has been approved for the use in children 8 and older and escitalopram (Lexapro) has been approved for use in children 12 or older (Reference 1). FDA approval indicates that the drugs have passed certain minimum research standards demonstrating that the drugs are effective for treating a particular disorder in a particular group. Prozac and Lexapro are drugs that belong to a class of antidepressants known as selective serotonin reuptake inhibitors or SSRIs. These drugs work selectively on the neurotransmitter serotonin and are believed to increase it in the brain, thereby reducing depression (Ref 2 and 3).
Non-FDA Approved SRRIs
If one medication does not work physicians will often try another or two medications in combination. SSRIs are considered the preferred medications for treating depression in adolescents because they have fewer side effects than other types of antidepressants (Reference 2). Other common SSRI antidepressant medications include sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa) and fluvoxamine (Luvox). If a FDA approved drug does not work physicians will often prescribed one of these; however, the FDA has recommended that Paxil not be used in adolescents due to increased suicide risks (Reference 1).
Other Non-Approved Medications
Tricyclic antidepressants work on several different brain neurotransmitters and include amitriptyline (Elavil), desipramine (Norpramin), imipramine (Tofranil), nortriptyline (Pamelor), and clomipramine (Anafranil). These drugs are not approved for use with adolescents by the FDA. Nonetheless, they are still often prescribed to adolescents as they treat depression in adults equivalently to SSRIs and may be effective when SSRIs are not; however, they have more side effects such as dry mouth, constipation, nausea, blurred vision, drowsiness and rapid heartbeat. Other medications such as the atypical antidepressants and MAO inhibitors are not well studied for use in adolescents and at the time of this writing are not generally prescribed for them (reference 2 and 3) .
Issues with Antidepressants
Antidepressant medications are prescription medications that should only be taken under a physician’s supervision. Most adolescents respond within 4 to 6 weeks during which time the physician may slowly increase the dosage as the adolescent gets used to the drug. After 6 to 8 weeks the physician can determine if the medication is not effective and either add a medication or change it. The physician will want to continue medication for about 9 to 12 months after the depression has lifted and then taper down the dosage as stopping it abruptly can result in severe reactions. Many experience a return of depression after discontinuation so physicians often recommend maintenance or long-term medication use (ref 2 and 3 for all).